Project Summary The consequences of youth violence have a massive financial toll on society, as well as long-term psychosocial and physical effects on the victim and communities. Perpetrators of violence also face many challenges, such as problems with mental and physical health, school performance, employment, and engaging and maintaining healthy relationships. Without a doubt, youth violence has a tremendous impact on everyone involved. Fortunately, youth violence is a preventable epidemic. Yet, high-risk youth are often difficult to reach and engage in prevention strategies. A solution to this problem is hospital-based violence prevention. Each day over 1,300 youths are admitted to the emergency department for violence-related injuries. This traumatic event can serve as a powerful precipitant for change. Hospital-based violence prevention programs, such as Bridging the Gap (BTG), capitalize on this catalyst and engage these high-risk youth. Unfortunately, many of these youths come from impoverished communities, where resources are low, protective factors are sparse, and community-levels of violence are high. Without a community-level prevention strategy, hospital-based violence prevention programs may be limited in keeping youth from engaging in violence once they leave the hospital. Thus, it may be that an integrative approach is the best strategy for cross-cutting violence prevention for high-risk violently injured youth. Using a sample of 120 violently injured youth (12-17 years) recruited from Virginia Commonwealth University Trauma Center (VCUTC), we aim to evaluate if BTG youth have greater reductions in multiple forms violence when the youth comes from a community receiving Communities that Care Prevention System and Walker-Talker/Plain Talk Community Engagement Model (BTG+CTC Plus) versus BTG youth from communities without CTC Plus. Also, we aim to evaluate the economic efficiency of BTG and BTG+CTC Plus using surveillance data. Lastly, we aim to test the presence and strength of mediators that may link early adversities to violent behavior for youth who receive BTG in communities with CTC Plus as compared to youth who receive BTG in communities without CTC Plus. To achieve these aims, the candidate and mentorship team (Drs. Sullivan and Farrell) have developed a comprehensive training plan outlining a series of training and research goals. These goals include training in risk/protective factors for multiple forms of violence, hospital-and community- based violence programs, program evaluation, and economic efficiency evaluation. This K01 proposal will capitalize on the existing expertise of the candidate. The research represents an important contribution towards understanding what works for cross-cutting violence prevention in violently injured youth. The institutional environment is recognized by the CDC as an Academic Center of Excellence in Youth Violence Prevention, and the mentors have shown longstanding success mentoring and implementing violence prevention research. The institutional environment enhances the candidate's goal of developing research independence as a highly trained scientist, with the ultimate aim to reduce and prevent violence, consistent with NCIPC's research priorities.